So, you know you need a
fee schedule that keeps you competitive with other emergency physician groups and you want one that establishes an appropriate payment for the services you provide. The question is, what is the best way to develop this system?
Dieter Lehnortt, MA, manager of compliance for Southwestern Medical Center in Dallas, TX, is the former reimbursement director at the American College of Emer-
gency Physicians (ACEP) and a former coding and reimbursement consultant to emergency medicine groups. He also has presented numerous educational seminars about developing appropriate emergency medicine professional fee schedules.
Here are his tips for designing a schedule for your group:
1. Find out whether your current schedule is in the ballpark. Before you establish a schedule that links your fee structure with RVUs, you need to make sure the fees you start with are within an appropriate range. How do you do that when you cant directly discuss your fees with someone else? Purchase one of the published books of fee ranges per CPT code. There are a number of different resources on the market with this information, says Lehnortt. There are many that will custom tailor those numbers to a particular region or state. Use such references to compare each of your fees with the range published for that code in your region. If you dont take this first step, then your fees will be internally consistent, but they may still be way out of whack with the marketplace, he notes.
2. Decide on an established RVS system and use its RVUs. Once you know your fees are not exorbitantly high or low for your area, decide on a system of relative value units to apply for each code. Some groups, like MedAmerica, Inc., which manages 500 emergency physicians in several groups in California, use Medicares Resource-Based Relative Value System (RBRVS) as its base, says Jeri Bennett, MedAmericas manager of coding and reimbursement.
Our schedule is 99 percent based on RBRVS, although we look individually at some of the codes we use and make adjustments, she notes.
Using a relative value system ensures that the fees for each code are linked to the amount of resources and services required for that procedure. Using Medicare or McGraw-Hill or another nationally recognized system ensures that these values are ones that have been widely accepted, adds Lehnortt.
There are several sources for getting RVUs. McGraw-Hill, I think, publishes the best-known set, he advises. Remember, also, that you are not just treating Medicare patients; you need a relative value scale that is going to cover all of your codes. Medicare doesnt publish RVUs for some codes, particularly pediatric codes, because Medicare, for the most [...]
